August 20, 2020
Rural Health, Telehealth and the New Normalcy: An Executive Check Up with Dr. Susan Turney
Susan Turney, MD, is CEO of Marshfield Clinic Health System, which has more than 50 locations in Wisconsin. She joined us last year for the Art of Change, where she talked about setting the vision of a healthcare organization and what it was like to lead a system through dramatic growth and change.
One upended year later, we wanted to know how Turney’s perspective has changed for Marshfield and the healthcare industry itself.
Jarrard Inc.: Crises are clarifying. What’s been clarified for the healthcare industry over the past few months?
Turney: First, our country was unprepared for this pandemic, and we’re learning many difficult lessons because of it. We didn’t have the infrastructure in place fast enough to contain the spread of this virus. This is something that will be part of a national discussion moving forward – how we can better prepare for crises of this magnitude.
Second, rural healthcare desperately needs help. It was in profound crisis before COVID-19. Now hit with a once-in-a-century pandemic, many organizations in rural health are barely hanging on.
Please expand on that. What are you seeing specifically?
National data tells us rural Americans are older, sicker and poorer than their urban counterparts. Just for our system’s service area, median income is about $8,000 less than the state average.
Rural Americans suffer higher rates of obesity, chronic disease and mental health issues while having less access to primary and specialty care services. They also face unique challenges – like a scarcity of public transportation options and a pronounced deficit in broadband internet access when compared to individuals living in urban areas.
Because we care for aging and generally poorer populations, rural health providers are seeing their payer mix progressively tilt toward Medicare and Medicaid. This means that, despite caring for patients with more complex and/or chronic conditions, the health systems charged with providing that care have fewer resources.
Policymakers must recognize the true cost and obstacles of providing healthcare in rural areas. They must support innovation and ensure that rural providers are not left behind.
What approaches to delivering care during this pandemic have you found valuable at Marshfield and worth continuing?
Partnerships are an area that have come to the forefront that can and should carry forward even after this crisis ends. During COVID-19, we’ve worked extensively with local and state public health entities on gathering accurate public health information. And we’ve worked extremely closely with our community partners to help meet the unique needs of each community we serve.
We’ve worked to expand programs and services such as our Community Connections Team that screens individuals for social determinants of health, then connects those in need to community resources. Pre-COVID-19, this program was for our patients only, but after hearing from our community partners, we opened it up free of charge to any community-based organization servicing at-risk individuals.
We were one of the first in Wisconsin to offer a COVID-19 Community Support Fund, totaling $400,000. Funds were used by local organizations to fill dire community needs. In all, more than 70 organizations received funding.
We launched an iPad donation program where used iPads are collected from our communities, repurposed by our IS department and distributed to patients who are suffering from social isolation.
This deepening of partnerships with our communities has been essential to caring for people during these times, and I’m optimistic that can continue and improve our health infrastructure in the long term.
Has your personal perspective changed on the work you do? If so, how?
Prior to this pandemic, we were seeing a bit of a revolution with the industry realizing that the environment a person spends their life in is every bit as important as the care we provide directly to patients.
What is their housing situation like? Do they have stability at home? A steady job? Access to education? Access to healthy food? Do they have meaningful relationships? Do they live in a safe community?
These are all questions that drive directly at a person’s social determinants of health. In the early stages of the pandemic our job as a system was largely to keep people home and away from our facilities. The pandemic has shown us more than ever how important all the things that happen outside the doctor’s office are to a person’s health.
Change has been forced on all of us. Whether healthcare organizations (and individuals) were embracing or resisting it, it happened. Where is the greatest area of opportunity to use that forced change for good?
From our perspective, telehealth has been a game-changer and essential tool during this time. In a three-month period from March through June, our System completed 50,000 telehealth encounters. That’s four times the number of encounters we completed in all of 2019.
This has been clarifying in a couple of ways. First, we’re finding that patients really like receiving care this way, particularly in terms of convenience. And providers like it as well – in some instances, they can be more efficient.
It is important that some of the loosening of restrictions around telehealth that have been brought forward during the pandemic continue into the future. Out of necessity, millions of patients and thousands of providers across the country are engaging with telehealth for the first time, or at least more than they have in the past. This approach needs to be made permanently sustainable for a number of reasons.
We have no idea how long we’ll be dealing with the effects of COVID-19. And even when things return to some sense of “normalcy,” telehealth is a vital tool that needs to be expanded to provide more comprehensive, convenient and affordable care to Americans. This would be particularly helpful for rural Americans who often have to drive one to three hours for in-person care.
How do healthcare providers move forward to best serve their communities in an uncertain future?
This moment is a paradigm shift in healthcare where we’re realizing that delivering care within the flow and fabric of a patient’s everyday life is the future. We can’t rely on an office visit every four months to manage folks with chronic diseases. They are better served with frequent touchpoints with their care team to ask questions, get information and advice and actively manage their condition.
With the expansion of telehealth, I can see more and more care going this direction. Maybe you don’t have a two-hour appointment every four months. Maybe instead you have a bi-weekly, 15-minute phone chat with your provider.
This is going to require a shift from providers and patients, but I think this moment of crisis can help accelerate people’s willingness to accept change. It’s also going to require that we create a regulatory environment where providers can expand telehealth and be financially viable in doing so.